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Nutrition and Mesothelioma Treatment

For malignant mesothelioma patients who plan to be treated aggressively with surgery, chemotherapy and/or radiation, or for patients currently undergoing treatment, nutrition plays a vital role in helping them to feel better and stay stronger. For many patients, however, side effects of the disease itself or side effects of the treatment they have chosen, may make it difficult to maintain their nutritional health. Appetite, taste and the ability to eat enough food or to absorb the nutrients from the food they do eat may be affected, resulting in malnutrition and inability to fight infection.

The loss of appetite or the loss of the desire to eat is termed, anorexia, and is the most common cause of malnutrition in cancer patients. Some patients may already be anorexic at the time of diagnosis; almost all patients with advanced cancer will develop anorexia. Cachexia, or wasting syndrome, causes weakness and loss of weight, fat and muscle. This may occur when the patient is eating enough, but is not able to absorb nutrients. Once cachexia occurs, it is difficult to completely reverse, therefore, monitoring nutritional needs early is essential. If a patient begins with a healthy diet before undergoing treatment, they will have reserves to help keep up their strength during treatment, be better able to cope with side effects if they occur and help maintain their defenses against infection.

Following are ways in which various treatments affect nutrition:

Surgery

Surgery increases the body's need for nutrients and energy in order to heal tissues, fight infections and recover properly. If the patient has lost a considerable amount of body weight prior to surgery, a high-calorie, high-protein diet may be recommended. After surgery, patients may receive nutrients through intravenous feeding, through a tube, through a Clear-Liquid Diet or through a Full-Liquid Diet.

Chemotherapy

Chemotherapy uses drugs to stop the growth of cancer cells either by killing the cells or by preventing them from dividing. Unfortunately, healthy cells which normally grow and divide rapidly, such as those in the mouth and/or digestive system may also be affected. Side effects of chemotherapy such as nausea and vomiting, loss of appetite, diarrhea, constipation, sore mouth or throat and changes in the taste of food, can be a detriment to healthy eating, and without proper nourishment, it may be difficult for patients to regain healthy blood counts between treatments. With good nutrition therapy, however, chemotherapy patients can get the nutrients they need both to tolerate and to recover from treatment.

Radiation

Radiation therapy uses high-energy rays or other types of radiation to kill cancer cells, however, healthy cells near the cancer may be affected, also. Side effects may vary, depending on the dose and the part of the body treated. Radiation therapy to the chest may cause infection in the esophagus, difficulty in swallowing, esophageal reflux and nausea and/or vomiting. Radiation to the abdomen or pelvis may cause diarrhea, nausea and/or vomiting and inflammation and/or blockage of the intestines. Radiation therapy may also cause fatigue, which can lead to decreased appetite or desire to eat.

In general, patients undergoing aggressive cancer treatments are encouraged to eat high-calorie, high protein foods such as milk, cheese and cooked eggs. Following are some ways to increase calories and protein in the diet.

Ways of increasing calories include:

Butter and Margarine	Add to soups, mashed and baked potatoes, hot cereals, grits, rice, noodles and cooked vegetables. Stir into cream soups, sauces and gravies. Combine with herbs and seasonings, or spread on cooked meats, hamburgers and fish or egg dishes. Use melted butter or margarine as a dip for seafood or raw vegetables.
Whipped Cream	Use sweetened on hot chocolate, desserts, gelatins, puddings, fruits, pancakes and waffles. Fold unsweetened into mashed potatoes or vegetable purees.
Milk and Cream	Use in cream soups, sauces, egg dishes, batters, puddings and custards. Use on hot or cold cereal. Mix with noodles, pasta, rice and mashed potatoes. Use whole milk instead of low-fat. Use cream instead of milk in recipes. Make hot chocolate with cream and add mashmallows.
Cheese	Melt on top of casseroles, potatoes and vegetables. Add to omelets. Add to sandwiches.
Cream Cheese	Spread on breads, muffins, fruit slices and crackers. Add to vegetables. Roll into balls and coat with chopped nuts, wheat germ or granola.
Sour Cream	Add to cream soups, baked potatoes, macaroni and cheese, vegetables, sauces, salad dressings, stews, baked meats and fish. Use as a topping for cakes, fruits, gelatins, breads and muffins.
Salad Dressings and Mayonnaise	Use with sandwiches. Combine with meat, fish, egg or vegetable salads. Use in sauces. Use in gelatin dishes.
Honey, Jam and Sugar	Add to breads, cereals, milk drinks, fruits and yogurt. Use as a glaze for meats or chicken.
Granola	Use in cookies, muffins and bread batters. Sprinkle on yogurt, ice cream, puddings, custards and fruit. Layer with fruit and bake. Mix with dried fruits and nuts.
Dried Fruits	Serve for breakfast or as a dessert or snack. Add to muffins, cookies, breads, cakes, cereals and puddings. Bake in pies and turnovers. Combine with cooked vegetables, such as carrots, sweet potatoes, yams and acorn or butternut squash. Combine with nuts and granola.
Eggs	Add chopped, hard-cooked eggs to salads and dressings, vegetables and casseroles. Make a rich custard with eggs, milk and sugar. Add extra hard-cooked yolks to deviled egg filling and sandwich spread. Add extra eggs or egg whites to custards, puddings, quiches, scrambled eggs, omelets and pancake or French toast batter.

*Chart courtesy of The National Cancer Institute

Ways of increasing protein include:

Hard or Semisoft Cheese	Melt on sandwiches, breads, muffins, tortillas, hamburgers, hot dogs, other meats or fish, vegetables, eggs, desserts, stewed fruits or pies. Grate and add to soups, sauces, casseroles, vegetable dishes, mashed potatoes, rice, noodles or meatloaf.
Cottage Cheese/Ricotta Cheese	Mix with or use to stuff fruits and vegetables. Add to casseroles, spaghetti, noodles and egg dishes, such as omelets, scrambled eggs and souffles. Use in gelatins, pudding-type desserts, cheesecake and pancake batter. Use to stuff pasta shells or manicotti.
Milk	Use milk instead of water in beverages and in cooking. Use in preparing hot cereals, soups, cocoa and puddings. Add cream sauces to vegetables and other dishes.
Nonfat Instant Dry Milk	Add to regular milk and milk drinks, such as pasteurized eggnog and milkshakes. Use in casseroles, meatloaf, breads, muffins, sauces, cream soups, mashed potatoes, puddings, custards and milk-based desserts.
Ice Cream, Yogurt and Frozen Yogurt	Add to carbonated beverages, such as ginger ale or cola. Add to milk drinks, such as milkshakes. Add to cereals, fruits, gelatin desserts and pies. Blend or whip with soft or cooked fruits. Sandwich ice cream or frozen yogurt between cake slices, cookies or graham crackers. Make breakfast drinks with fruit and bananas.
Eggs	Add chopped, hard-cooked eggs to salads and dressings, vegetables and casseroles. Make a rich custard with eggs, milk and sugar. Add extra hard-cooked yolks to deviled egg filling and sandwich spread. Add extra eggs or egg whites to custards, puddings, quiches, scrambled eggs, omelets and pancake or French toast batter.
Nuts, Seeds and Wheat Germ	Add to breads, muffins, cookies, pancakes and waffles. Sprinkle on fruits, cereals, ice cream and yogurt. Toast as a topping or use in place of bread crumbs.
Peanut Butter	Spread on sandwiches, toast, crackers, muffins, waffles and pancakes. Use as a dip for vegetables and fruits. Blend with milk drinks. Swirl through soft ice cream and yogurt.
Meat and Fish	Add chopped, cooked meat or fish to vegetables, salads, casseroles, soups, sauces and biscuit dough. Use in omelets, souffles, quiches and sandwich fillings. Wrap in pie crust or biscuit dough as turnovers. Add to baked potatoes.
Beans / Legumes	Cook and use peas, legumes, beans and tofu in soups or add to casseroles, pastas and grain dishes that also contain cheese or meat.

*Chart courtesy of The National Cancer Institute

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